Healthcare Provider Details

I. General information

NPI: 1821977679
Provider Name (Legal Business Name): MRS. SOPHIE LYONS-COVARRUBIAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2025
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

892 WORCESTER ST STE 210
WELLESLEY MA
02482-3729
US

IV. Provider business mailing address

892 WORCESTER ST
WELLESLEY MA
02482-3718
US

V. Phone/Fax

Practice location:
  • Phone: 781-214-1078
  • Fax:
Mailing address:
  • Phone: 781-214-1078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: